Take the Cannolis

Accident victim Barbara Esrig recently told her story on NPR’s StoryCorps. A devastating car crash broke 164 bones and left her with five cranial paralyses. On a respirator, unable to speak and with a patch over one eye, Esrig lay in a hospital bed listening as a student doctor described her brutal prognosis. Reading over her chart, he told her even if she survived she might never again be able to talk, to taste or to smell.

Barely able to move, Esrig used a pair of chopsticks to point at letters on an alphabet board and spell out, “Life is not worth living if you can’t eat cannolis.” Then she wrote, “Now put down the chart, and give me a hug.” And he did.

That young physician and Esrig became friends through her lengthy recovery. He later told her she reminded him why he wanted to become a doctor. “I needed to have people show me that I was something other than a car accident, that I was something other than a diagnosis. That I was a whole human being,” Esrig said.

Patients are people, too.

That’s the basic tenet of home care and a concept HME providers embrace every day. But it seems much harder for this industry’s regulators to understand.

Focused on cutting costs and fighting fraud, worthy endeavors to be sure considering Medicare’s precarious finances, a series of recent rules has propelled a number of providers to say they will exit the program. Others say they will be forced to cut services. And that could leave the people Medicare is set up to serve in the lurch.

In its original announcement of competitive bidding, CMS estimated after its full implementation only half of the DMEPOS providers then doing business with Medicare would remain. The agency also expects more than 25,000 providers to drop out due to costs associated with a new surety bond requirement and accreditation. It’s a reasonable assumption others will close as a result of rules that require continued service to oxygen beneficiaries, with no additional payment, for two years beyond the 36-month cap.

Universal reaction from HME providers to all of these mandates, which they point out turns HME into a commodity, has been concern for patients. After all, they live with their patients every day. They are in their patients’ homes. They see those patients in the grocery store line and visit with their families at church.

I was struck by comments from a rural county pharmacist who told CMS he was worried about his patients during a teleconference earlier this month. Because he provides DMEPOS to his customers mainly as a service, since there are no other pharmacies or HME companies for 20 miles in any direction, he said he simply could not justify the cost of accreditation. He wondered when he dropped that business how those patients would be cared for in an area with no other options.

When he was told CMS did not believe there would be a problem via beneficiary access to mail order supplies, the pharmacist sounded incredulous. “You are leaving an entire county without an acute service,” he said.

Our nation must do some tough math as attention turns to health care/Medicare reform. But subtracting the “people” part from the home care equation is not the answer.